Spouses and kids could cut costs for some. But what about all those people who live alone?

Share with Email

Thank you for sharing!

In North Dakota, about 13 percent of residents ages 15 to 64 live alone.

In the District of Columbia, the percentage of residents who live by themselves in what the Census Bureau calls “nonfamily households” is about 20 percent.

Someday, those statistics could contribute to a hole in the supply of long-term care (LTC). Policymakers are hoping neighbors, cousins, nieces, nephews, friends, children, roommates, and, above all, spouses will provide enough free help to keep frail older and moderate disabled people in their homes, without costly home care services, as long as possible. “Informal care” can maximize the quality of life of older people and people with disabilities and minimize the amount of paid, “formal care” they use.

Insurers recognize the protective role of having a spouse by offering discounts for married consumers who buy private long-term care insurance (LTCI).

The SCAN Foundation has estimated that about 44 million U.S. residents were providing informal care for adults ages 50 and older in 2009, and that 87 percent of the adults who needed long-term care were getting the services from informal caregivers. In June 2013, the Congressional Budget Officers said replacing the casual, blue-jeans brand of informal care delivered in the United States in 2011 with formal, paid, tuxedo-level care would have cost $234 billion.

One rip in the knees of blue jeans care: Fewer Americans seem likely to have ready access to family caregivers. Fewer are marrying. The percentage of U.S. residents ages 35 and older who have never married bottomed out around 6 percent in 1980 and climbed to 12 percent in 2010.

The likelihood that U.S. adults will have children, either inside or outside of a marriage, is also falling. The percentage of U.S. women ages 40 to 44 who have no children jumped to 18 percent in 2008, from 10 percent in 1976. Meanwhile, in 2010, 27 percent of U.S. households were one-person households, up from fewer than 10 percent in 1950.

Rose Kreider and Jonathan Vespa, the authors of a recent paper on the rise of the one-person U.S. household, say the number of one-person households is increasing partly because Americans are making more money and can afford to live on their own.

Access to spouse care – or having the traits needed to have a spouse in the first place – can affect easy-to-measure acute medical care outcomes as well as LTC costs. Dr. Ayal Aizer of Harvard Medical School and other cancer researchers reported in the Journal of Clinical Oncology in September 2013 that having a spouse had an obvious effect on the life expectancy of patients with cancer. At any given time, a married patient with cancer was 20 percent more likely to be alive than a patient with cancer and no spouse.

Married women with cancer were 16 percent more likely to be alive than comparable single women. Married men with cancer were 23 percent more likely to be alive than comparable single men. “For prostate, breast, colorectal, esophageal, and head/neck cancers,” the researchers wrote, “the survival benefit associated with marriage was larger than the published survival benefit of chemotherapy.”

Vicki Freedman and colleagues discovered back in 1994 that having any kind of attachment with anyone cut the risk of a woman entering a nursing home by two-thirds. For men, having a wife was by far the most important factor reducing the risk of nursing home entry. Men without wives were more than three times as likely to go into nursing homes.

In May 2010, a team led by Judith Kasper of Johns Hopkins estimated in the Journal of Gerontology: Social Sciences that living with the same adult child continuously reduced the need of entering a nursing home 48 percent, and that living with a spouse reduced the need 28 percent.

When people do enter a nursing home, having a spouse can reduce the amount of care they need. Anne Kelly of the University of California at San Francisco and her colleagues studied older people who stayed in nursing homes at the end of their lives. The single people in the study stayed in nursing homes 4 months longer than the married people.

Government agencies are trying to increase the supply of family care by providing more advice, telephone support and counseling access for the relatives who do still provide care.

One possible silver lining for single people and their LTC planning advisors: Women who live on their own may be better positioned to fund LTC planning arrangements than women who live with others. Robert Plotnick says unmarried women have an average of 12 percent to 33 percent more income and 33 percent more wealth than otherwise comparable married women. Unmarried, childless men have incomes similar to those of comparable men with children, but they tend to have more wealth.

The next page features a table giving the percentage of residents ages 15 to 64 who live on their own in each state and the District of Columbia. Interestingly, the two jurisdictions at the top of the table – the District of Columbia and North Dakota – are known for being great markets for private LTCI products.

To try to hint at what the future might hold for each jurisdiction’s supply of informal care, we also provide a table showing the percentage of working-age residents who live alone divided by the percentage of older residents who live alone. Older people are more likely to live alone in every jurisdiction. In states in which the gap between younger adults’ live-alone rate and older adults’ live-alone rate is narrower, that might be a sign the older adults’ live-alone rate will soon be climbing.

Allison Bell

Allison Bell, ThinkAdvisor's insurance editor, previously was LifeHealthPro's health insurance editor. She has a bachelor's degree in economics from Washington University in St. Louis and a master's degree in journalism from the Medill School of Journalism at Northwestern University. She can be reached at abell@alm.com or on Twitter at @Think_Allison.

ThinkAdvisor

Free unlimited access to ThinkAdvisor.com which provides advisors, like you, with comprehensive coverage of the products, services and trends necessary to guide your clients in making critical wealth, health and life decisions.

Exclusive discounts on ALM and ThinkAdvisor events.

Access to other award-winning ALM websites including TreasuryandRisk.com and Law.com.